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Senate Hearing Highlights How Single-Payer Will Ration Health Care

doctor's waiting room
Image CreditDennis Sylvester Hurd / Flickr / public domain

The testimony showed a surprising amount of consensus about ‘free’ health care creating a level of demand for care that doctors and hospitals could not meet.


One might think that, given our polarized times, a topic like single-payer health care would yield to partisan disputes. Think again.

At a recent Senate Budget Committee hearing on the concept proposed by the committee’s chairman, Sen. Bernie Sanders, I-Vermont, witnesses from the left, right, and center all agreed: Single-payer would lead to unmet demand for care.

They disagreed on the nature and import of this conclusion, but the testimony showed a surprising amount of consensus about “free” health care creating a level of demand for care that doctors and hospitals could not meet all patient requests.

Massive Demand for ‘Free’ Care

Coming from the center, the non-partisan Congressional Budget Office (CBO) summarized its prior analysis of five hypothetical single-payer systems. CBO concluded that in all five cases,

The increase in demand for personal health care would exceed the increase in supply, resulting in greater unmet demand than the amount under current law….The increase in unmet demand would correspond to increased congestion in the health care system, including delays and foregone care.

This testimony summarized a persistent theme in CBO’s work. Its December 2020 analysis of the five hypothetical single-payer proposals used the word “congestion” to describe single-payer’s impact on the health-care system no fewer than 28 separate times. Some might find “congestion” an overly polite euphemism for waiting lists and rationed care.

Regardless, CBO’s frequent use of the term explains why the budget office admitted it has not conducted a formal analysis of Sanders’ legislation. As the ranking member and then chairman of the Budget Committee, Sanders could have used his seniority to ask for—and receive—a full “score” of his bill years ago. The fact that he has not done so speaks volumes, and suggests Sanders does not want the budget office to quantify exactly how long patients might have to wait for care under his approach.

Hundreds of Billions in Unmet Care Needs

From the right, Mercatus Center scholar Chuck Blahous spent part of his testimony dissecting how CBO’s work provided some estimates of potential unmet demand within the health-care system. In the CBO scenario that most closely resembled the single-payer system Blahous modeled in 2018, Blahous noted CBO’s conclusion that “$254 billion of this new demand for health care would simply go unmet.”

Another hypothetical example CBO examined—one that Sanders said during the hearing most closely resembled the parameters of his bill—featured even more unmet demand for care. In this example, which would see the federal government providing low reimbursements to doctors and hospitals, while making cost-sharing (e.g., co-payments, deductibles, etc.) virtually non-existent for patients, Blahous highlighted how “CBO found that the majority of additional demand ($319 billion out of $591 billion) would go unmet.”

Of course, the accuracy of CBO’s estimates depends in no small part on the accuracy of its assumptions. Blahous raised the possibility that a single-payer system could achieve as much in the way of administrative savings as the budget office believes. And his position has a logic about it; after all, how often has more government involvement reduced bureaucracy?

Blahous found that, if half of nurses’ potential administrative reductions went unrealized—that is, if single-payer reduced their paperwork burden by only 40 percent, instead of the 80 percent CBO claims—then “over 97% of the additional physician and hospital services sought under [single payer] wouldn’t be delivered.” In other words, practically all of the additional demand for “free” health care would go unmet.

Rationing a Feature, Not a Bug?

One of the witnesses supporting single-payer implicitly agreed with the gist of Blahous’ analysis. Harvard Medical School professor Adam Gaffney criticized the CBO model, because “it errs in contextualizing constrained increases in use as unmet demand rather than salubrious reductions in the large amounts of unnecessary and even harmful care that are currently delivered.”

Translation: Yes, you may have to wait months for a knee operation, or a heart transplant—but you’re reducing “unnecessary” care in the process!

Sarcasm aside, Gaffney and people like him say they can eliminate the wasteful spending—and only the wasteful spending—within the health-care system. Such a feat seems as likely as pulling out all the green M&Ms (e.g., the “wasteful” care) from a jar, while leaving all pieces of candy with other colors (e.g., the necessary care) completely untouched.

As much as it makes sense to eliminate wasteful care, the idea that any health system, let alone one run by the federal government, can eliminate only wasteful care with no adverse consequences seems fanciful.

Delusions of Grandeur

Then again, the entire movement for single-payer seems marked by flights of fancy. Another witness at the hearing, Abdul El-Sayed, included the following characterization of single-payer in his testimony: “A single solution for all our health care problems.”

This kind of statement is as dishonest as it is embarrassing. No one proposal, no matter how big or sweeping, could presume to solve all the problems within the more than $4 trillion health-care sector. I would never presuppose that any single conservative policy proposal could solve all the country’s problems, and not just because I believe that government can’t solve all the country’s problems.

While some may try to deny it, the Senate budget hearing illustrated one of the prime downsides of single payer—waiting lines for, and rationing of, care. I only hope that I never live long enough to see these predictions of the impact of socialized medicine in the United States come to reality.